Dialectical Behaviour Therapy (DBT) Skills - Distress Tolerance (Part 2)

DBT is big on skill development, one of the things that first drew me to this type of therapy. Skills are developed across four different areas - Distress tolerance, Mindfulness, Emotion regulation and Interpersonal effectiveness. Whenever I am working with someone, I really encourage the practice of these skills daily, so that when there is crisis, it's easier to recall the skill and apply it in the moment. Learning the skills of DBT can help manage intense emotions before they take over and take control. Distress tolerance skills can be helpful in those moments when it feels overwhelming, helping to get through the distress. Below is another skill from DBT which you may find useful, as this helps to shift the body in more of a relaxed state which in turn can help bring stability during distress (Therapist Aid, 2025).

TIPP - Temperature change, Intense exercise, Paced breathing, Progressive muscle relaxation

Temperature change - splash your face with cold water, take a (not too) cold shower, apply ice cubes or an ice pack to your skin, hold ice cubes in your hands or place a wet cloth on your face or neck. This works by cooling the body, which slows the heart rate and breathing, both of which typically increase during times of distress. It also has the effect of shifting attention from thoughts and emotions to the experience of the coolness.

Intense exercise - 15 minutes of exercise such as walking, jogging, bike riding, swimming, dancing,star jumps or skipping can be effective. This works by expending some of the energy that can build up during times of intense emotions, or providing energy when those emotions are resulting in lethargy and low motivation. It also helps by releasing endorphins, one of the natural 'feel-good' chemicals, and helping to reduce stress levels.

Paced breathing - inhale through the nose for the count of 4, hold the breath for 7, and exhale through the mouth for the count of 8. Repeat this a few times. This works by helping to lower blood pressure and heart rate, while giving the body some oxygen.

Progressive muscle relaxation - sit or lie down, and starting at the feet, tense the muscles for 5 seconds and as you slowly release the tension, say the word 'relax'. Then repeat these steps with the calf, thigh, abdomen, back, chest, arm and face muscles. This works by helping the body let go of stress and the build up of energy which can happen during emotional distress. To take this practice one step further, try focusing on the physical sensations as the tension of the muscle is released. Not only will this be relaxing, it is also practicing mindfulness which can shift the mind from thoughts and emotions.

Let's see how this works through an example....

Christy was woken up very early by her inconsiderate neighbour revving their car outside of her bedroom window. She hadn't had much sleep that night and woke up furious. She could feel the anger brewing inside, the volcano bubbling away, heart racing, temperature rising, shallow breathing, fists clenched. She really wanted to race outside and unleash on the neighbour. However, Christy wanted to be able to manage the feeling of intense anger and not take actions which she may later regret, so she worked through the TIPP skill she had been practicing. First, she went to the bathroom and splashed cold water on her face a few times. The cold water was a slight shock at first, but she could feel the coolness and the slowing of her breathing.

Next, she put on a playlist with upbeat tracks (one she had prepared earlier and had saved it in her favoured streaming platform for ease of access) and danced to the music for 15 minutes. Not only did the music have a positive impact, but the exercise from dancing used up some the energy built up from the anger. Next she tried some paced breathing, remembering to make sure the exhalation was longer than the inhalation. After about 3 rounds of this, she felt a sense of calm come over her body. And finally, she lay back on her bed and starting at her feet, engaged in progressive muscle relaxation. Even though she was feeling much more calm before even getting to the fourth step of TIPP, she decided to do the last step to start her day with relaxation rather than rage.

Seeking Support

If you are finding emotions or behaviours difficult to manage, speaking with a registered health professional can be a helpful first step. They can provide an assessment and discuss evidence-based treatment options tailored to your needs. If you are in immediate distress or feel unsafe, contact Lifeline Crisis Support on 13 11 14, 000 for an emergency, or present to your local hospital emergency department.

Disclaimer: This information is intended for general educational purposes and does not replace professional advice, diagnosis, or treatment. Individual experiences vary, and support should be tailored accordingly.

REFERENCES

1. Therapist Aid. (2025). TIPP: DBT distress tolerance skills. Therapist Aid LLC. https://www.therapistaid.com/therapy-worksheet/dbt-tipp

2. Dialectical Behaviour Therapy. (2024). T10: TIPP. DBT Dialectical Behaviour Therapy. https://dialecticalbehaviortherapy.com/distress-tolerance/tipp/